Friday, April 29, 2016

The Public Disapproves of Health Law,  But Democrats Want to Expand It

Below is an  article from Kaiser Health News,  which encourages others to publish their material.

Democrats Increasingly Want Expansion Of Health Law, Poll Finds”

By Jordan Rau April 28, 2016
The results come as Democratic presidential candidate Bernie Sanders has repeatedly derided the law for including too many concessions to the private health care industry and costing consumers too much.
The Kaiser Family Foundation poll found that 51 percent of Democrats want to expand the law, a 15 point increase since December. (KHN is an editorially independent program of the foundation.)
“This increase may be due to the rhetoric surrounding universal health care in the Democratic presidential campaign, with both candidates advocating universal coverage as a goal,” the pollsters wrote.
This month overall disapproval for the law continued to climb, growing to 49 percent of the public while support for the law decreased to 38 percent. Views about the law have seesawed since it was passed in 2010, but opponents have outnumbered supporters consistently since last fall.
Democratic support for the law slightly slipped this month, and now a quarter of party members hold an unfavorable view. Among those, four in 10 want to expand what the law does and almost three in 10 want to scale it back or repeal it entirely. The pollsters did not ask specifically how people would like the law to be expanded.
The law remains unpopular with three-quarters of Republicans, while independents are split.
The poll found that voters of all persuasions view the economy and jobs as the most important issue in the presidential election, with 30 percent saying they would like the presidential candidates to discuss those topics. National security was the next subject the public identified as important, followed by immigration and border control and then health care, which 15 percent of voters wanted candidates to talk about.
The poll was conducted among 1,201 people from April 12 through 19. The margin of error is +/- 3 percentage points. The poll respondents included 379 Democrats; answers from them had a margin of error of +/- 6 percentage points.

The Indiana Primary and ObamaCare
As the Indiana Republican primary approaches next Tuesday, I am reminded of  then-governor.  Mitch Daniel’s,  2010 remarks on the state of the union and ObamaCare.   Daniels is now president of Purdue University.
“We’ve been through a global recession. Now we’re fighting through a stalled recovery. Revenues are the lowest they’ve been in half a century. Their finances a wreck, many states have effectively sunk into bankruptcy.

Indiana is still afloat. In fact, we’ve fared better than most. We continue to meet our obligations without raising taxes, and the reserves we carefully built and protected will get us through the downturn.

But as if we did not already have enough on our plates, the passage and implementation of Obamacare presents us with a whole new set of challenges and a costly to-do list.

I note with special sadness that first and foremost amongst the bill’s consequences will be the probable demise of the Healthy Indiana Plan (HIP). This program is currently providing health insurance to 50,000 low-income Hoosiers. With its Health Savings Account-style personal accounts and numerous incentives for healthy lifestyle choices, it has been enormously popular and successful.

Cost of “Reform” to Indiana

Obamacare’s expansion of Medicaid, soon to cover one in every four citizens, will not only scoop up most of HIP’s participants, but will also cost the state between $3.1 and $3.9 billion over the next decade.

Of course, it’s a misnomer to even refer to this as “reform.” It doesn’t reform anything. Instead, it perpetuates and magnifies all the worst aspects of our current system: fee for service reimbursement, “free” to the purchaser consumption, and an irrationally expensive medical liability tort system. It’s a sure recipe for yet more over-consumption and overspending.

Since my election, my state coworkers have had the choice of Health Savings Accounts in lieu of traditional health care plans. The first year this option was made available, some 4 percent of us signed up for it. Six years later, more than 70 percent of our 30,000 state workers have opted for the personal account.

This trend has had a startlingly positive effect on costs for both employees and the state. State employees enrolled in the consumer-driven plan saved more than $8 million in 2010 compared to their coworkers in the old-fashioned preferred provider organization (PPO) alternative. Indiana will save at least $20 million in 2010 because of our high HSA enrollment.

It has also been the source of significant changes in behavior, as state workers with the HSA visit emergency rooms less frequently and are more likely to use generic drugs than co-workers with traditional health care. Hoosiers enrolled in HIP have experienced similar changes in behavior with generic drugs now accounting for 84 percent of all prescriptions used by enrollees.

This is a sharp contrast to the prevalent model of health plans in this country that encourage individuals to buy health care on someone else’s credit card. What seems free will always be over-consumed, compared to the choices a normal consumer would make. Hence our plan’s immense savings.

The condescension of the ‘reformers’ is misplaced. It turns out that typical Americans are neither too dense nor too intimidated to make sound decisions about their own health. This is, of course, a fact that national policy makers sadly ignored during their overhaul of our health are system. Now the rest of us are left to pick up the pieces.”

Thursday, April 28, 2016

Pew Survey: Obamacare Disapproval Surges

The latest Pew survey shows views of the Affordable Care Act are still more negative than positive.

The number of Americans who disapprove of ObamaCare increased by 10 percentage points in a recent survey.

ObamaCare has extended health insurance coverage to nearly 20 million Americans – but that has done little to shift the public's opinion about the law.

54% Approve, 44% Disapprove

According to a survey just released by the Pew Research Center, 54 percent of Americans disapprove of the 2010 Affordable Care Act compared with 44 percent who approve of the law.. The divide has also become more pronounced since July, when 48 percent of respondents said they approved of the law and 49 percent said they disapproved.

The survey was conducted April 12 to 19, among 2,008 adults

Effects of Law More Negative  Than Positive

The findings showed 31 percent of respondents say the health care law has had a mostly negative effect on them and their families, while 23 percent say the result has been positive and 45 percent say they have seen little change. Pew noted that the percentage of respondents saying they have seen little change has declined in the last three years but that the law’s “personal impact” has consistently been more negative than positive in its polling.

Perception of  Law Deeply Divided along Party and Racial Lines

The survey found that 78 percent of Democrats approve, compared with only 9 percent of Republicans. Republican approval of the law had risen from 11 percent in February last year to 18 percent last July.  

Republican views of Obamacare became more negative after the exchanges, or marketplaces, experienced technical glitches, making it difficult for Americans to purchase tax-subsidized insurance. Though the website has improved, opinions from Republicans have not, the survey shows.

Differences in opinion by race also were apparent. Whites disapprove of the law by a nearly 2-to-1 margin – 64 percent approve while 33 percent disapprove – and blacks overwhelmingly support it, showing an approval score of 83 percent. The majority of Latinos, 57 percent, also approve of the law.
Source:   "Survey: ObamaCare Disapproval Surges, "  US News and World Report,  April 25, 2016

Wednesday, April 27, 2016

In One Era and Out the Other
Now this is not the end. It is not even the beginning of the end. But it is perhaps, the end of the beginning.
Winston Churchill (1874-1965)
I listened to Donald Trump and Hillary speak after their sweeping victories in the East, and to Donald Trump’s foreign policy speech.   
From these listenings,  I sense the end of  the era of centralized  government and the Nanny state,  big  political establishments left and right,  traditional  elitist and intellectual dominance ,  a timid and hesitant  foreign policy ,  strict liberalism  and stringent conservatism,  top-down media messaging,  health policies dictated by HHS and CMS and  ACOs,   collectivism imposed from above as opposed to individualism bubbling up from below. 

I do not sense the end of dominant hospital systems.  In Connecticut, where I live, two huge hospital systems,  Yale New Haven and Hartford,  each with revenues over $1 billion, have the lion's share of medical markets, both inpatient and outpatient through their central hospitals, acquired hospitals, and peripheral facilities, which feed  the mother ships. 

Elsewhere,  however,  I sense the beginning of an era of dispersed and customer-oriented  markets,  smaller  and more flexible economic entities, a bolder and more decisive foreign policy,  a mix of liberalism and conservative views, more migration of businesses across national borders,  the economic rise of the IT-skilled and the a fall of those not skilled workers, and  an increase in hacking and terrorist related  crimes  and a decrease in physical violence and large scale wars.    

A Dual System
In health care,  I sense the rapid emergence of a dual health system.

One  will be dominated and controlled by government –Medicare, Medicaid, ObamaCare,  and large integrated hospital organizations.  These systems are generally reimbursed through 3rd parties,  and for the general run of patients,  have a significant flaw, high deductibles, which, for many patients, rules them out as a source of care.

The other  part of the system will be  characterized by cash-only and direct care delivered by individuals, small groups, and entrepreneurs offering convenient, personal, and direct care at multiple sites where efficiency is more important than power or size of the organization.  
In many cases,  these smaller outlets will be more economical for health care customers because of skyrocketing health premiums and deductibles, which render routine car unaffordable. 

ObamaCare will survive in the dual system because it has taxpayer dollars to prop it up. But because of surging premiums and deductibles and  UnitedHealth backing out of 34 markets, it is in trouble and financially unsustainable.     Its fate depends on public approval which has dropped to 44% and to politics.   Republicans have vowed to repeal either its mandates or the law as a whole. 

Transitions to More Market-Based Entities
The transition  to a dual, information and data- geared health system,  will not be easy, particularly among those who lose status, income, and benefits.   There will be suspicious and hostile to the information elite, rich people, the well-educated, the  immigrants,  and those with  disappearing jobs, and loss of income and status.
Among some, particularly the millenials,  I sense a revolutionary attitude. The millenials  are now the large demographic group in the U.S.  Many will throw up their hands and shout, “Let the government do it.  Let the government equalize incomes. Let the government tax the rich and the prileged.   Let the government provide Medicare-for-all and free college tuitions.” 
But the past era will  not be resuscitated.  It is breathing its last, for we are witnessing the end of  big government as we know it,  With the downsizing of government and politics,  will come the rise of efficient markets outside of government power and control.

Tuesday, April 26, 2016

These Crazy Times

Peggy Noonan hit it on the head when she wrote in the Wall Street Journal:
“We’ve had a lot to absorb, the rise of an outlandish outsider; the lurch to the left in the other party; the popular rise of a socialist. Alongside that, the enduring power of a candidate even her most supporters accept as corrupt. Add the lowering of standards, the feeling of no options, the coarsening, and all the new estrangements…too much is being lost…the great choice in a nation of 320 million may come down to a Crazy Man versus Criminal.”  (“The Moment When 2016 Hits You,” WSJ, April 23-24, 2016).
Add to this dismal thought the faltering, sputtering, downwardly spiraling health care law, with its skyrocketing premiums and deductibles and its ever narrowing choices of health plans and doctors, and you begin to wonder, why and how did it come to this?
To begin with, Donald Trump is not crazy, crazy as a fox perhaps.   Hillary Clinton is not criminal, opportunistic and self-serving, perhaps, but not criminal.  And although ObamaCare is badly flawed, with innovations. public revolts and withdrawals, and emergence of private sector alternatives, health reform will straighten itself out, but  perhaps only after repeal of its mandates.
Why these crazy times?   The answer may lie  in emergence and maturation and transition to the Information Age.   
With ubiquitous computers and sophisticated algorithms, we are now deep in cyberspace.   Everybody thinks they know everything.  From thousands of different sources, they think they, not the government, know the answers.   They should be the customers, not the victims of government.
Individualism and diversity reigns, and government and centralization fades.   People have become narcissistic and self-serving and have lost their sense of national collectivism and purpose.  They trust themselves more than government.
 There is a decline in the status and power of the traditional elites, the establishment, and of government itself.  
There is a rise in power and income of those with computer skills and a fall of those without those skills in the middle class, who are experiencing rising expenses and failing incomes and ballooning medical costs.  Unfunded entitlement liabilities  are bankrupting the nation, and taxes are climbing without a concomitant climb in benefits.
With universal access to information,  people believe they, not government, know the answers.  And they think they, not the establishment and all who that term signifies,  should be the beneficiaries of their taxes. 
People are mad as hell at social and personal injustices.   They are mad as hell.  They have decided they aren’t going to take the governmental paralysis that has set in and they are lashing out, frustrated and angry.  They want outsiders to articulate their cause and control their destinies  not government insiders who, they believe, have rigged the system against them.
Into the void created by government parylysis steps  Donald Trump.  He knows people  want action and straight talk.   He capitalizes on their  anger by talking straight in the language of the street,  by being omnipresent in the media and by being at their beck and call,  by issuing  multiple tweets, and saying he will make sweet deals to make America great again.
 Into the void steps Bernie Sanders,  who promises he will make government deliver, by routing insiders and delivering Medicare-for-a;; ,  college tuitions, and millions of infrastructure jobs  to save the middle class.
Into the void steps Hillary Clinton, who says the problem resides in racial and gender biases, capitalism greed,  and Republicans who do not give a whit about the middle class but only in enriching banks and Wall Street, of which she is an integral part.
People on all sides of the political aisle find this all hard to fathom.   As Peggy Noonan remarks in her column,  this is not history as usual.  “This is big, what we’re living through.”

Monday, April 25, 2016

Quote of Day:  Premiums and Losses Unacceptable
Working-class individuals are paying too much, and insurers are losing too much.  Something has to give.”
  ObamaCare isn’t likely to enter an insurance death spiral; there’s too much federal money propping the whole thing up. But it isn’t on track to become a stable, self-sustaining insurance pool either, because very few middle-class families want to get their insurance through the exchanges. Which means the law is not only unstable financially, it is politically unstable as well.”

James Capretta,  senior fellow of Ethics and Public Policy Center and visiting fellow at American Enterprise Institute,  “The Increasing Instability of ObamaCare,”  National Review, April 25, 2016